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Diagnosis of cholelithiasis in children
Last reviewed: 04.07.2025
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Physical examination
For the diagnosis of cholelithiasis in children, a thorough anamnesis is important. Body temperature is usually unchanged; the diagnostic value of "point" pain symptoms (Yonash, Riedel, Lyakhovitsky, Kharitonov, etc.) in children is low. The symptoms of Grekov-Ortner, Ker, Mussi are rarely detected. Hepatomegaly is not typical for children with cholelithiasis. Moderate protrusion of the liver (by 1-2 cm) from under the edge of the costal arch along the right midclavicular line is possible with a violation of the outflow of bile.
Laboratory research
First of all, blood serum enzymes are examined - indicators of cholestatic syndrome (liver fraction of alkaline phosphatase, y-glutamyl transpeptidase, leucine aminopeptidase, etc.). The content of triglycerides in the blood is significantly increased; the concentration of total lipids is reduced. Simultaneous increase in the level of triglycerides, non-esterified fatty acids and phospholipids indicates a pronounced disorder of bile acid metabolism.
Instrumental research
Ultrasound is the most informative; detection of gallstones in sick children occurs in 95-99%.
X-ray methods, including cholegraphy and CT, are of little use in diagnosing cholelithiasis, as they only allow detection of calcified gallstones.
Magnetic resonance cholangiopancreatography in children with cholelithiasis is used to detect bile duct stones, including intrahepatic bile ducts, as well as developmental anomalies of the biliary tract. In terms of diagnostic significance, the method is not inferior to endoscopic retrograde cholangiopancreatography.
To diagnose the "disconnected gallbladder", bile duct scintigraphy with Tc-substituted imidodiacetic acids is used. The absence of a marker in the gallbladder on the scangram 90 minutes after intravenous administration of the drug indicates obstruction of the cystic duct. The method also allows diagnosing disorders of the concentration and contractility of the gallbladder, assessing the patency of the extrahepatic bile ducts, and dysfunction of the sphincters of Oddi and Lutkens.
Differential diagnostics
Gallstone disease is differentiated from esophagitis, gastritis, gastroduodenitis, chronic pancreatitis, chronic duodenal obstruction. Cases of hospitalization of children with the picture of "acute abdomen" present particular difficulties. In such a situation, gallstone disease is differentiated from acute appendicitis, strangulated hernia of the esophageal opening of the diaphragm, gastric ulcer and duodenal ulcer, intestinal volvulus, intestinal obstruction, and in girls - from gynecological diseases (adnexitis, ovarian cyst torsion, etc.). Similar symptoms are possible in diseases of the urinary system - pyelonephritis, cystitis, urolithiasis, etc.
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